Objective postoperative pain assessment using incentive spirometry values: a prospective observational study

2021 ◽  
Vol 11 (3) ◽  
pp. 315-324
Author(s):  
Matthew J Hallman ◽  
Nancy Dorinsky ◽  
Yueting Wang ◽  
Quefeng Li ◽  
Robert Isaak ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Observational Study ◽  
Pain Control ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Surrogate Data ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Subjective Pain ◽  
Incentive Spirometry

Aim: Determine if incentive spirometry (IS) values correlate with postoperative pain control. Design: Prospective observational study. Setting & participants: A total of 100 patients undergoing major abdominal procedures at the University of North Carolina Medical Center. Interventions: Patients studied as a single cohort. All patients received thoracic epidural analgesia preoperatively. Outcome: Preoperative and daily postoperative numeric pain scores, subjective pain description and IS values were collected for all patients. Results: There was a strong correlation with IS values relative to baseline for both the numeric pain scores (p < 0.0001), postoperative day (p < 0.0001) and the subjective pain score (p < 0.0007). Conclusion: IS values are an objective surrogate data point for pain control after surgery, particularly when followed over time and compared with a preoperative baseline value.

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

2019 ◽  
Vol 30 (05) ◽  
pp. 465-471
Author(s):  
Joseph A. Sujka ◽  
Charlene Dekonenko ◽  
Daniel L. Millspaugh ◽  
Nichole M. Doyle ◽  
Benjamin J. Walker ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Randomized Trial ◽  
Pain Control ◽  
Pectus Excavatum ◽  
Prospective Randomized Trial ◽  
Epidural Group ◽  
Thoracic Epidural ◽  
Pain Scores

Abstract Introduction Postoperative pain control remains the primary reason for inpatient stay after minimally invasive repair of pectus excavatum. In a previous study, our group reported that early pain control was better in patients managed with a thoracic epidural, while late pain control was better in patients managed with patient-controlled analgesia (PCA). After revising our epidural transition and modifying the PCA protocol, we conducted a multi-institutional prospective randomized trial to evaluate these two pain control strategies. Materials and Methods Patients were randomized to epidural or PCA following minimally invasive repair of pectus excavatum with standard protocols for each arm. Primary outcome was length of stay with secondary variables including mean patient pain scores, complications, and parental satisfaction. Scores were pooled for the two groups and reported as means with standard deviation. Results were compared using t-tests and one-way analysis of variance with p-value < 0.05 determining significance. Results Sixty-five patients were enrolled, 32 epidural and 33 PCA. Enrollment was stopped early when we developed an alternative strategy for controlling these patients' pain. There was no difference in length of stay in hours between the two arms; epidural 111.3 ± 18.5 versus PCA 111.4 ± 51.4, p = 0.98. Longer operative time was found in the epidural group. Nine patients in the epidural group (28%) required a PCA in addition to epidural for adequate pain control. Mean pain scores were lower on postoperative day 0 in the epidural group compared with the PCA groups, but were otherwise similar. Conclusion In our prospective randomized trial, PCA is just as effective as thoracic epidural in decreasing early postoperative pain scores after minimally invasive repair of pectus excavatum.

scholarly journals Circumcision in children: postoperative analgesic efficiency of transversus abdominis plan block vs caudal epidural block: a prospective observational study

2021 ◽  
pp. 1
Keyword(s):  
Postoperative Pain ◽  
Observational Study ◽  
Postoperative Analgesia ◽  
Prospective Observational Study ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Caudal Epidural

Background and objective: Circumcision is one of the most common operations and can cause postoperative pain, fear, and anxiety for children. This study aims to compare the effects of transversus abdominis plane (TAP) block and caudal epidural (CE) anesthesia on postoperative analgesia after circumcision in providing postoperative pain control. Methods: Eighty boys aged 1 to 14 years who underwent elective circumcision surgery under general anesthesia either with USG-guided TAP block or with CE block for postoperative analgesia were enrolled consecutively to this prospective observational study equally in each group. Postoperative pain scores and need for rescue analgesia were recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in mean age and Aldrete scores (p > 0.05). Body mass index (BMI) of the caudal block group was statistically lower than the TAP group (p < 0.05). While there was no statistically significant difference between the groups in 30th-minute VAS values (p > 0.05), the CE block group's 1st, 2nd, 4th, 8th, 12th, 18th, and 24th hour VAS values were statistically lower than the TAP block group's (p < 0.05). Conclusion: USG-guided TAB block under general anesthesia was not associated with lower postoperative pain scores and delayed rescue analgesia need compared with CE block in patients who underwent elective circumcision surgery. CE block provided superior analgesia than the USG-guided TAP block after elective circumcision surgery in this study.

scholarly journals Characterization of  self-anticipated surgical pain prior to general anesthesia - a prospective observational study

2021 ◽  
Author(s):  
Wei-Shu Chang ◽  
Yi-Ting Hsieh ◽  
Moa-Chu Chen ◽  
Shu-Ching Chang ◽  
Tzu-Shan Chen ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Observational Study ◽  
General Anesthesia ◽  
Pain Intensity ◽  
Pain Score ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Perioperative Period ◽  
Pain Scores

Abstract Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (P<0.001). Higher anticipated pain scores (preoperative NRS³4) were associated with higher actual postoperative pain levels (P=0.032) in the PACU and higher total equivalent opioid use (P=0.001) for acute pain management during the perioperative period.Conclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

scholarly journals The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

2020 ◽  
Author(s):  
Wei-Shu Chang ◽  
Yi-Ting Hsieh ◽  
Moa-Chu Chen ◽  
Shu-Ching Chang ◽  
Tzu-Shan Chen ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Observational Study ◽  
Pain Intensity ◽  
Prospective Observational Study ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Pain Scores

Abstract Background: Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain.Results: A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.532, 95% confidence interval 1.125-2.086; P=0.007). Patients who took regular benzodiazepine at bedtime (P=0.040) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P<0.001). Although higher anticipated pain scores (NRS³4) were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit.Conclusion: This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

scholarly journals Evaluation of Contralateral Oblique and Lateral Views for Mid-Thoracic Epidural Access: A Prospective Observational Study

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. E51-E59
Keyword(s):  
Observational Study ◽  
Epidural Space ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Lateral View ◽  
Pain Clinic ◽  
Thoracic Region ◽  
Oblique View ◽  
Thoracic Epidural ◽  
Measured Angle

BACKGROUND: The mid-thoracic region has been known to be the most difficult area when accessing epidural space despite using fluoroscopy. Contralateral oblique (CLO) view has been considered for use; however, it has not been evaluated in the mid-thoracic region. OBJECTIVE: To evaluate the CLO view for mid-thoracic epidural access (TEA). STUDY DESIGN: A prospective observational study. SETTING: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. METHODS: A total of 30 patients participated in this study. After securing the mid-thoracic (T4–8) epidural space, fluoroscopic images were obtained. The needle tip location relative to the ventral interlaminar line (VILL), and the needle tip and laminar visualization were measured and analyzed on the CLO views at 40, 50, 60 degrees, and measured angle, and the lateral view. RESULTS: The needle tip was clearly visualized in all CLO views, compared with the lateral view (100% vs. 36.7%, P < 0.001). The visualization of the laminar margin and the needle tip location on (or just anterior to) VILL using the CLO measured angle were significantly clearer compared with those in the CLO view at 40 and 50 degrees and the lateral view (laminar margin: 40˚, 56.7% vs. 3.3%, P < 0.001; 50˚, 56.7% vs. 26.7%, P = 0.012; 90˚, 56.7% vs. 26.7%, P = 0.035; needle tip location: 40˚, 96.7% vs. 26.7%, P < 0.001; 50˚, 96.7% vs. 63.3%, P = 0.002; 90˚, 96.7% vs. 66.7%, P = 0.012). There was no difference in these values between the CLO view at 60 degrees and CLO measured angle. LIMITATIONS: Subjective and ambiguous criteria of evaluation may induce bias despite final measured values based on the consensus of an independent investigator. CONCLUSION: A CLO view at 60 degrees and CLO measured angle view can provide clearer visualization and more consistent needle tip location than the lateral and other CLO angle views for mid-TEA. A CLO view at 60 degrees and CLO measured angle views could be used to identify the needle location and achieve success in mid-TEA. KEY WORD: Chronic pain, contralateral oblique view, fluoroscopy, lateral view, mid-thoracic, pain management, epidural analgesia, ventral interlaminar line

scholarly journals Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei-Shu Chang ◽  
Yi-Ting Hsieh ◽  
Moa-Chu Chen ◽  
Shu-Ching Chang ◽  
Tzu-Shan Chen ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Observational Study ◽  
Pain Intensity ◽  
Pain Score ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Pain Scores

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. Conclusion This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

Lumbosacral paraspinal interfascial plane blocks for pain control after feminizing genital gender affirmation surgery

2021 ◽  
Author(s):  
Sudipta Sen ◽  
Johanna B de Haan ◽  
Grace Guvernator ◽  
Andrzej P Kwater ◽  
Xuan T Langridge ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Case Series ◽  
Erector Spinae ◽  
Anesthetic Techniques ◽  
Pain Scores ◽  
Gender Affirmation ◽  
The Usa ◽  
Gender Affirmation Surgery ◽  
Regional Anesthetic

Aim: Feminizing genital gender affirmation surgery (fgGAS) is increasing in prevalence in the USA. Management of postoperative pain following fgGAS is challenging. We report a series of patients where post-fgGAS pain was adequately controlled with paraspinal blocks. Materials & methods: This is a case series of three patients who received bilateral lumbar and sacral erector spinae plane blocks after fgGAS. Block techniques, medications administered, opioid requirements and pain scores were reviewed. Results: Erector spinae plane blocks provided adequate analgesia for 24–48 h following the block. Conclusion: Currently, there are two regional anesthetic techniques described for the treatment of postoperative pain after fgGAS. We describe two additional approaches as options for improved pain management in this patient population.

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